Provider Demographics
NPI:1568574754
Name:BRUNO, MARYANNE (PNNP, CNM)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:BRUNO
Suffix:
Gender:F
Credentials:PNNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 HIGH STREET
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5507
Mailing Address - Country:US
Mailing Address - Phone:303-860-9990
Mailing Address - Fax:
Practice Address - Street 1:1719 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1235
Practice Address - Country:US
Practice Address - Phone:303-860-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991570176B00000X
COAPN.0001561-NP363L00000X, 363LP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP1700XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPerinatal
No176B00000XOther Service ProvidersMidwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20177828Medicaid